The tragic death last September of a Macon, Georgia, infant in a grocery store parking lot reminds us of the very real danger to children when riding in a common form of “transportation”—the shopping cart. The 3-month-old was secured in his infant seat perched on the child seating area of the shopping cart when he and the CR toppled from the cart as it went over a parking lot speed bump.

Unfortunately, this is only one extreme example of an all-too-common problem. In a study published in 2009, the U.S. Consumer Product Safety Commission (CPSC) estimated that, on average, more than 21,000 U.S. children under age 5 are treated in emergency rooms every year for injuries involving shopping carts, and three-fourths of these injuries are to the head and neck. According to a 2006 American Academy of Pediatrics (AAP)technical report, falls from the cart and cart tip-overs account for 58 percent and 26 percent of the injuries, respectively. (Among children under 2, tip-over injuries are much more frequent, accounting for fully 40 percent of the injuries.)

CRs and Shopping Carts Don’t MixAt the root of this problem is an ongoing quandary—what’s a parent to do with a baby or small child when the shopping must be done? In an attempt to address this, some early infant CRs had clip features built into the shell for the purpose of securing the CR atop the wire frame of the shopping cart. Realizing the danger, these features have long been eliminated from modern CR designs, and CR manufacturers state unanimously at conferences and through instructions that CR products should never be used on or in a shopping cart.

Behavior Modification is a ChallengeHowever, despite these warnings from CR manufacturers, children are still commonly seen in infant CRs on shopping carts. And, despite similar warnings on the carts themselves, babies, toddlers, and older children still ride in carts in any number of unsafe ways and often don’t wear restraint straps provided. In fact, studies have shown that educational efforts, when used alone, have little effect on these behaviors. One found that intensive efforts with flyers, signs, and recorded messages over the store’s public address system bumped the level of restraint strap use on carts up from one percent to a still-low 14 percent. Having a store representative talk to the parent helped more to bring usage up, but half of kids still continued to ride without the cart’s built-in restraint straps.

Cart Design—Stuck in the 20th Century? Another approach is to consider the cart itself. Are there ways, both active and passive, that today’s shopping cart could be made to reduce the likelihood of falls and tip-overs? Typical carts could indeed improve in ways that include:
Improved design for stability.
Lower child-seating areas to reduce the potential for severe injury in the event of
a fall. (Lower seating areas also improve overall cart stability.)
Improved restraint strap design to lessen fall likelihood.
Buckle designs that thwart “escapees.”

In the 1990s, an inventor designed a restraint that would automatically secure the child when he was seated in the cart. Though this innovation has not become mainstream, it raises the question: Are there untapped ways that shopping carts could be made safer by taking advantage of the explosion of technology that has occurred in recent years?

Current Cart Standards LackingAlthough regulations for shopping cart design have been in effect for many years in Europe and Australia, it wasn’t until July 2004 that the current, voluntary U.S. safety specifications for shopping carts, ASTM F2372-04, were published in the U.S.

However, in a 2006 technical report and policy statement, “Shopping Cart-Related Injuries to Children,” the AAP pointed out that the U.S. standard is inadequate because it is missing two components that are key to child safety:
1) It doesn’t address cart stability, and
2) It only provides for the testing of buckles, not the entire restraint system. (Moreover, the AAP notes that it only addresses buckle testing by referring to another standard that is not relatable, and therefore these procedures are inconsequential.)

The AAP concluded by recommending that the current U.S. standard be revised to make these improvements and urged the CPSC to monitor and enforce the standards.

In the nearly six years since the AAP issued its policy statement, the CPSC has not responded to its recommendation for revision and seems unlikely to do so anytime soon. In a featured article in the e-magazine Standardization News in January/February 2011, Paul Giampovolo, chair of the committee that developed the standard and president of Safe-Strap Co. (maker of a shopping cart restraint strap product), praised the standard, saying, “The standard put everyone on the same page, and the compliance with the standard is very high.” Though he goes on to say that more needs to be done, he cites only increased educational and compliance efforts.
What Can Child Safety Advocates Do?CPSTs and other concerned safety advocates should inform parents that a child’s infant CR should never be used with grocery carts and that all CR manufacturers prohibit this. The AAP recommends against placing a CR on the seat or in the basket—or even using an infant quasi-restraint that comes built into the cart—because there are no adequate standards to ensure cart stability. For infants, a better plan is to leave the baby at home with another caretaker, or consider using a front- or backpack.

For older children who ride by sitting in the shopping cart, parents should respect the warnings noted on the cart. Restraint straps that are included on shopping carts are a useful deterrent for falls and should not be disregarded just because they may seem flimsy compared to a CR harness. Children must be supervised at all times and should never be allowed to stand up in the cart or to ride in or outside the basket area. Carts that include a special area in which young children can ride, such as a pretend car, have the safety advantage of being low to the ground.

CPSTs can take advocacy to the next level by following AAP recommendations that urge child advocates to encourage businesses that provide customers with shopping carts to adopt safety strategies, including offering supervised in-store child-play areas, providing carts with designs that improve child restraint and cart stability, and developing in-store and community-wide education, warning, and incentive programs.